It is a message from a place where grief and sorrow live, scrawled on a pink, heart-shaped sheet of paper:

"To my little angel. Although I say goodbye today, you will always be with my mind, heart and soul. Please understand that this wasn't your time because you are better off in the hands of God than mine at this moment."

Martha Rial, Post-Gazette A woman's message written after an abortion at Allegheny Reproductive Health Center in East Liberty. Click photo for larger image.

A few more sentences, and then, it is signed, "always and unconditionally, your mommy."

And then there's this letter, also pink and heart-shaped, signed "Mom":

"I didn't let your dad know about you, simply because I'm ashamed. In my heart I will miss you but physically I don't have the means to take care of you and your older sister. I will never label you a mistake, because God obviously thought you should have been here, even though I beg to differ."

These are letters from women who have just had abortions at the Allegheny Reproductive Health Center in East Liberty. They are posted -- dozens of them -- on the walls of the clinic for other patients to read and to think about.

They are not easy to read, but then, "what about abortion ever is easy?" asks Claire Keyes, center executive director.

"Life is not simple. No one ever came into my clinic saying, 'Hello there, I want to exercise my constitutional right to an abortion.' "

Fathers and boyfriends are allowed to express their feelings: "This situation is very hard for me and my girlfriend, but this is the only thing we can do," said one. "I would like to have a baby with her," adds another, who writes in a special journal kept for men in the clinic's waiting room. "But not now, not like this, a mistake."

Keyes, 61, is a veteran of the abortion rights movement and has been with the center for 25 years. She describes herself as strongly supportive of legalized abortion, approved in the Roe vs. Wade Supreme Court decision 31 years ago this coming Thursday .

But in the 1980s, something began to dawn on her.

	Martha Rial, Post-Gazette Many of the messages on the hearts are prayers. Click photo for larger image.

"We in the movement, those of us in the clinics at the beginning, were so caught up in the early euphoria about winning a right to an abortion, we weren't listening to what the patients were saying. They weren't talking about abortion in the same way we were. They weren't talking about the constitution or women's rights. And many of them weren't talking about a bunch of cells, either. They might call it 'my baby,' even though they were firm about going through with the procedure. Many of them expressed relief, but many also talked about sadness and loss. And we weren't paying attention."

So almost 15 years ago, Keyes, along with a group of other independent abortion providers around the country decided to listen harder.

In November 1989, about a dozen of them formed a new group, calling themselves "the November Gang," which Keyes describes as a "think tank" that helps abortion providers "think outside the box" when it comes to helping their patients.

In general, most abortion clinics adhere to an informed consent model, which provides women with as much medical information as possible about the procedure. They also have patients fill out a form discussing their concerns.

But Keyes and her other colleagues went farther. On a screening form patients complete during an initial visit, they ask very careful questions: Was this a difficult (check one) or easy decision? Whose decision was it? Does the man involved know of your decision? What are your thoughts today about ending this pregnancy?

And then, patients are asked to circle all the words describing how they feel: sad, happy, angry, confident, guilty, confused, scared, relieved, numb, ashamed, resolved, selfish, trapped, irresponsible, peaceful, disappointed, comfortable, grieving, lost, supported, stupid, curious, nervous or "other."

Keyes emphasizes that clients are neither asked nor encouraged to express their feelings. If they want to talk, they can. If they want to write down their feelings, they can do that too.

And very rarely, after the procedure, Keyes has been asked to help "baptize" the remains of the fetus.

"Who am I to say no to these women, to tell them, no you can't do that? It isn't for me to judge, but to listen."

The demographics

Most of these women aren't girls. Only 7 percent of Keyes' clients are under age 18, she says. Many already have children or have health problems. And most seem resolved upon their decision.

"There are certainly women who get all the way here and change their minds," Keyes said. "And there are, in fact, women to whom we say, 'Look, we cannot do this abortion today, you are not sufficiently resolved, but you can come back.' "

	Martha Rial/Post-Gazette
	Claire Keyes, executive director of Allegheny County Reproductive Health Center

For those who are determined to proceed but want to talk about it, "First and foremost, the question is 'Will I ever be free of guilt?' " Keyes says. "That's followed by 'Will I ever go to hell?' 'Will God take one of my other children from me?' 'What gives me the right to decide which of my children lives and which dies?'

Keyes doesn't pretend to know the answers, but she points out to the patient that "from the beginning of time, women have decided which children should be brought forth and which could not be brought forth. It's no different today, it's just that it has a political overlay to it."

"What she's doing is a very basic counseling principle, where you go where the client is," says Amy Jonas, a former counselor at the clinic who helped Keyes develop the program.

Too many clinics discourage or even correct patients who refer to a baby instead of a fetus, Jonas said. "I visited this clinic in Ohio where they were surprised that people here were able to say 'baby.' I don't know how you can avoid that when you're working at an abortion clinic. Here, we say they can cry, they don't have to be liberated, it's OK to say: 'It feels like a baby to me.' "

Keyes' approach got some national publicity this past fall when Glamour magazine published a story about the November Gang. It prompted angry reaction on the Internet from abortion opponents. Former Watergate figure Chuck Colson, now an evangelical activist, wrote on a Christian Web site that the gang's approach was a "bizarre" perversion "of the counseling-centered approach pioneered by pro-life pregnancy centers... All the pink paper hearts in the world don't change the fact that abortion is taking a life with the mother's permission."

Helen Cindrich, local president of People Concerned for the Unborn Child, agreed.

"One of the saddest things that the abortion establishment is doing to women is convincing them that by writing a note or praying they're being absolved of killing their children,'' she said. "It's another way they're cheating women. Now they admit it's a baby, but it's OK if you say sorry. Maybe the reason you're sad is because you're doing away with your child."

	Martha Rial, Post-Gazette A comment left in a notebook in which husbands and boyfriends may express their feelings. Click photo for larger image.

Mainstream political advocates of abortion rights have also reacted with discomfort to the November Gang's approach.

Officials at NARAL Pro-Choice America refused to make president Kate Michelman available for comment for this story, but in the Glamour article Michelman said: "There may be forums and proper settings where someone would talk about the range of feelings that women have... but the pro-choice movement's job is not to wear every woman's feelings publicly. My job is to educate and inform and mobilize pro-choice citizenry to protect the right to choose."

And the November Gang's model generally isn't followed by most other clinics. Kim Evert, director of the Planned Parenthood affiliate in Pittsburgh, said their clinic's screening materials do not probe in the same detail as at Allegheny Reproductive Health Center, but patients are asked how they feel about the decision.

"If we sense they're having difficulty, we arrange for them to see professional counselors. We do some things that overlap [with Keyes] and we do some things differently, based more on a medical model."

Dr. Mitchell Creinin, director of Family Planning at the University of Pittsburgh, worries that stories about the November Gang and women grieving about their abortions may obscure the fact that, according to studies, "in general, women find having the procedure results in a significant improvement in the quality of their lives.

"Everybody has a different way of grieving, and we need to let them deal with it," he added. "But it's important to note that the vast majority don't have reactions like this. It's the exception, rather than the rule."

But Ron Fitzsimmons, president of the National Coalition of Abortion Providers, which represents 150 independent clinics around the country, thinks highly of Keyes' efforts.

"We need to have a national conversation about abortion," he said. "We have nothing to hide. The work we're doing is good. We are there to help women, and it's important to talk about abortion so that it's not a stigma, without sugarcoating it.

"Many clinic providers," he said, "came of age at a time when women were feeling empowered. It was 'I Am Woman,' 'Our Bodies Ourselves,' that sort of thing. Well, the conversations have changed. For the most part, this new generation of women has lived with legal abortion all their lives and don't remember all the struggles. And now, the anti-abortion folks are stressing all this hard stuff about abortion -- partial births, multi-dimensional sonograms -- that makes the debate much more difficult. We can no longer respond to that with 'it's your right to choose.' That's a hollow response.

"We need to recapture the notion that abortion is a difficult moral choice for women, but one that is, in fact, a moral choice."